Pyeloplasty is a surgical produce to operate on the renal pelvis in the kidney where the urine is collected after it is produced. At the junction of the renal pelvis and the ureter there can often be a blockage. This is called a pelviureteric junction (PUJ) obstruction and must be dealt with to avoid several long term complications including loss of kidney function, urinary infections and the formation of kidney stones.
Laparoscopic pyeloplasty employs fibre-optic instruments to operate on the blockage. Commonly known as ‘keyhole surgery’, a laparoscopy is a far less invasive procedure that reduces many of the risks associated with open surgery. Through the use of fibre-optic technology only very small incisions are made during the procedure and therefore it is a low-risk and minimally invasive operation. The procedure can also be performed robotically.
Laparoscopic pyeloplasty is performed while the patient is under a general anesthetic. Three small incisions are made in the abdomen. A laparoscope and small surgical instruments are inserted into the incisions where the urologist can then operate on the blockage.
After the blockage has been removed and the ureter reconstructed, a small plastic tube called a ureteral stent is placed inside the ureter to bridge the repair and help drain the urine from the kidney. This will usually remain for 6 weeks and can be removed by your doctor.
Laparoscopic surgery offers the significant benefit of rapid recovery compared to open surgery. Much less recovery time is needed to get back to work and normal activities.
Robotic Laparoscopic Pyeloplasty
Robotic pyeloplasty is very similar to laparoscopic surgery, however, instead of the surgeon using their own hands, the surgical instruments are attached to a robotic system that is controlled by the surgeon via a computer interface. The dexterity of the robotic system enhances precision, control and flexibility of the surgeon’s movements.
The advantages of robotic surgery include less bleeding and smaller scars, less pain and a quicker recovery, as well as the reduced risk of infection.
After the surgery patient are taken to recovery where they are monitored until the anaesthetic wears off, then they are taken to a hospital room to rest. Patients are typically required to stay for two to three nights.
After surgery a catheter is usually put in place but may be removed the following day. Pain at the incision site is common. Patients that underwent laparoscopic surgery may also experience some mild shoulder pain as a result of the gas used to inflate the abdomen during surgery.
Patients can usually return to work two to four weeks after the surgery. Heavy lifting and other strenuous activity is discouraged during this time. Driving is also discouraged until the patient is feeling 100 percent.
The ureteral stent can cause some discomfort, especially during urination where pain can occur in the back on the side near where the kidneys are located. Blood in the urine is also common.
The stent is usually taken out after 6 weeks. The procedure is fairly straightforward. It is performed under local aesthetic; the stent is removed using a cystoscope, which is inserted into the bladder via the urethra. This is a day procedure and doesn’t require an overnight stay in hospital.
Risks and Side Effects
As with any major surgery there are some risks involved with pyeloplasty, such as bleeding at the operative site, injury of the surrounding organs and infection. However, laparoscopy and robotic surgery both significantly reduce the risk of these complications. In very rare cases, complete removal of the kidney (nephrectomy) may be required.